8 CHANDLER RD - BUILDING PERMIT APP ,s . . the Comiromrealth of Massachusetts
Board of Budding Regulations and Standards I (1'
- \II'Nll'll'.\I.I I 1 '
. JVIaSS 1ChLISMS State Building Code. 780 C:NIR. 7"' edition 1 .yI:
Building Permit .Application TO COnStRICt. Repair. Renovate Or Demolish a R� / �
ogle- ur Tu o-1.'11nih Durlling
'this Section For Official Use Only
Building Permit Num
b
er Date Applied:
Si_n -
u mg Cuinnussione t'pectur a wldin, Date —
SECI']ON 1: SITE INFORMATION
1.1 Pro erh, address, 1.2 :kssessors Nlap & Parcel Numbers
e 7weoe Rel. _ -
L la Is this an accepted street' ves__ no Slap:\'umber Pancl ,Nuinhrr
1.3 Zoning Information:; 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tU Fromage itt)
1.5 Building Setbacks ift)
Front Yard Side Yards Rear Yard
Required Provided Required Pim sled Required Prodded
1.6 Water Supply: (SI.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone'! - -
Public ❑ Pri%ate❑ Check it yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 Owner[of Re
Name I Print) Address For Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repaus(s) ❑ alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specity:11Ipi✓ AOn{
Brief Desciption of Proposed Witt k':
r
SECTION J: ESTIMATED CONSTRUCTION COSTS
Ite.m. Estimated Costs: Official Use Only
(Labor and Materials)
I. Building .S h�J'00 �� t. Building Permit F In ee: 5 Indicate to fee is dc(enntncd:
❑ Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost' (Item 6) x multiplier x
i
1. Plumbing S 2. Other Fees: S
1. tStcrhanird (HVAC) S List: -- i
5. Mechanical [Fire S Total All Fees: S
Sup ression)
Check No. Check antntmt: Cush .-Amount:_
b. I'otal Project Cost: Sy 0 Paid in Full 0 Ou(standine Balance
yD� �o JV
SECTION 5: CONSTRUCTION SERVICES
5.1 I..icensed Cunslractiun Supervisor (CSI,)
Liecnac Number li\11icW,m D:ue
Name of CSI_- IloWer
I_Isl CSL T)pc(sec beluul _
lddrcss I v e Descri awn L Cnreslncted(11 lu 35.oU0 Cu Ft i
I R Resui,cd 1.@] F:unlly D„rllin_
.S Ignaull'C .VI AI:moniA Un lfy
RC Rc,idcnual Kaoline Cal ermy
I\dephour \1'S RcaiJrnu ul \1'indw, .i nd S:dme
S1= Residenual SuhJ Fuel liurnine \�+I iL m.v In,LJl.ii i �ii�
D Residential Deinoluum
5.2 Registered limit Improvement Contractor (IIIC) �9
/77
IIIC Company Name or IiIC Reeistr nt Nan lr Registration Number
P S O- O
141
W 1w / /O
AW r 72Vt&- �—IkL _xpuamm Date
Slgnamre VTelephone
I SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(NI.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed mud Submitted with this appltc:uiun. Failure ai provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached'.' Yes .......... ❑ No , , . _ ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. , as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7�b:: OWNEW OR AUTHORIZED .AGENT DECLARATION
1, 1 JR V'P I���61PF ' V , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate. to the best of my knowledge and -
behalf.
Print
Signature of Owner or Au zed Agent Date
(Signed under the 2ains and penalties of er ur )
NOTES:
I. An Owner who obtains a building permit to do his/her own uvrk, or an owner who hires an unreeislered CnnnCor
(,not registered in the Home Improvement Contractor (HIC) Program), will not have access to the arbill allon
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Progr:ml and
Construction Supervisor Licensing (CSL) can be round in 780 CMR Regulations I M.R6 and 110.10. respecfisely.
' When substantial work is planned, provide the intilrmation below:
Tonal floors area(Sq. Ft.l (including garage. finished basemendattics, decks m p(,rch)
Gross living area tSq. Ft.) Habitable room Cuunl
Number of fireplaces Number of bedrooms
Number of b:uhroomS Number of halt/baths
Tvpe of healing System Number of decks/ porches
-fypeof cooling system_ Unclosed Upon
3. '-Total Project Square Footage" may be substituted tilt "total Project Cost"